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304642
Access to long-acting reversible contraception for nulliparous women: Results from a cluster randomized trial
Tuesday, November 18, 2014
: 12:30 PM - 12:45 PM
Susannah Gibbs, MSPH
,
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Corinne Rocca, PhD, MPH
,
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Kirsten M.J. Thompson, MPH
,
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Philip Darney, MD, MSc
,
Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
Paula Bednarek, MD, MPH
J. Joseph Speidel, MD, MPH
,
Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA
Cynthia C. Harper, PhD
,
Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Unintended pregnancy is high - and use of long-acting reversible contraception (LARC) is low - among nulliparous and young women in the US. Healthcare providers have misconceptions about nulliparous women’s eligibility for LARC, particularly intrauterine devices (IUDs). We used data from the UCSF Bixby cluster-randomized trial of a provider LARC training to examine outcomes among young and nulliparous women. We recruited 1,500 sexually active women aged 18-25 who received contraceptive counseling and did not desire pregnancy at 20 intervention and 20 control clinics across the United States. We assessed provider LARC counseling and patient method selection and initiation. We used multivariable logistic regression with generalized estimating equations for clustering to assess LARC outcomes by intervention and parity. The trial was registered with ClinicalTrials.gov and followed CONSORT guidelines. Results showed that the provider training intervention increased LARC selection for all women (aOR=2.3 [1.6-3.1]). However, providers were less likely to discuss LARC with nulliparous compared to parous women (53% v. 63%, aOR=0.5 [0.4-0.7]), and nulliparous women were half as likely to select LARC (17% v. 36%, aOR=0.5 [0.3-0.6]) or to actually initiate use of a LARC method over a year (15% v. 32%, aOR=0.4 [0.3-0.6]). Among nulliparous women, the intervention had a larger effect on implant selection (2% v. 9%, aOR=4.1 [1.9-9.1]) than IUD selection (10% v. 13%, aOR=1.3 [0.8-2.1]). Efforts to increase LARC access for nulliparous women are needed, particularly for the IUD.
Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related research
Learning Objectives:
Describe the effects of a provider training about LARC on patient selection of LARC methods
Compare the provider LARC counseling received, and patient selection and initiation of LARC, between nulliparous and parous women
Explain implications for family planning service delivery to young nulliparous women
Keyword(s): Contraception, Adolescents
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I am a research analyst for the LARC research group at the Bixby Center for Global Reproductive Health and have completed graduate studies focusing on adolescent sexual and reproductive health. I have published on various adolescent health issues with colleagues from the World Health Organization and a variety of research institutions.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
